The must-read stories and debate in health policy and leadership.

The government’s new guidance on PPE procurement at the start of May – which said all major purchases had to go through the national procurement team – made an exception for “new, local or small suppliers”.

The exception appeared to allow Greater Manchester (which is supposed to be a devolved health and care system) to plough ahead on a deal with a local supplier which could deliver millions of face masks each week.

But the region was subsequently “strong-armed” into routing its orders through the Department of Health and Social Care, and six weeks later, is still waiting for confirmation. A similar thing happened with an order for PPE gowns, although this has now been approved by the DHSC.

It’s caused lots of frustration in Greater Manchester, which felt it had been navigating the pandemic with admirable levels of self-reliance and mutual aid.

HSJ understands Sir Mike Deegan, who heads up the acute leadership “cell” for the region, has attempted to intervene by raising concerns in a letter to national officials, calling for greater flexibility and autonomy.

The heady early days of “Devo Manc” – when one serious commentator drew parallels with the Magna Carta – feel like a distant memory.

Opiate addiction fears

Problems with dispensing drugs during the covid-19 crisis may be contributing to an “apparent increase” in deaths of patients receiving treatment for opiate addiction, the Care Quality Commission has said.

The regulator has said the increase in deaths “may be a result of some services stopping all daily dispensing of opiates” and has taken enforcement action against a “large national provider of substance misuse services” which “stopped all daily dispensing”.

The provider has not been named by the CQC as it is “entitled to an appeal period,” but the regulator told HSJ the provider had not recorded their risk assessments for their clients in relation to changes in drug dispensing. The CQC said the provider had now “assured us” individualised risk assessments were in place.

The CQC is now reviewing all deaths of people which have been reported by substance misuse services since 1 March due to concerns about the apparent increase and “that some of these deaths may be related to changes in prescribing practices in response to covid-19”.

It comes after many community pharmacies have had to close or change their operating practices to maintain social distancing during the pandemic.